Accommodative excess


In ophthalmology, accommodative excess occurs when an individual uses more than normal accommodation for performing certain near work. Accommodative excess has traditionally been defined as accommodation that is persistently higher than expected for the patient's age. Modern definitions simply regard it as an inability to relax accommodation readily. Excessive accommodation is seen in association with excessive convergence also.

Symptoms and signs

Causes related to [refractive errors]

Accommodative excess may be seen in following conditions.
Use of systemic drugs like Morphine, Digitalis, Sulfonamides, Carbonic anhydrase inhibitors may cause accommodative excess.

Causes related to diseases

Accommodative excess may occur secondary to convergence insufficiency also. In convergence insufficiency near point of convergence will recede, and positive fusional vergence will reduce. So, the patient use execessive accommodation to stimulate accommodative convergence to overcome reduced PFV.

Risk factors

A large amount of near work is the main precipitating factor of accommodative excess.

Pseudomyopia

Pseudomyopia also known as artificial myopia refers to an intermittent and temporary shift in refractive error of the eye towards myopia. It may occur due to excessive accommodation or spasm of accommodation.

Diagnosis

Differential diagnosis

Parinaud’s syndrome, which can mimic some aspects of spasm of the near reflex, such as excessive accommodation and convergence; however, pupillary near-light dissociation, not miosis, is a feature of Parinaud’s syndrome.

Treatment